Healthcare Provider Details

I. General information

NPI: 1336043736
Provider Name (Legal Business Name): JESSICA YOUNG LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17847 SE 97TH AVE
SUMMERFIELD FL
34491-8455
US

IV. Provider business mailing address

17847 SE 97TH AVE
SUMMERFIELD FL
34491-8455
US

V. Phone/Fax

Practice location:
  • Phone: 808-868-6769
  • Fax:
Mailing address:
  • Phone: 808-868-6769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number110475
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: